Dianne Feeney, associate director of quality initiatives for the Maryland Health Services Cost Review Commission (HSCRC), discusses reasons for potentially preventable readmissions as well as the related costs for these readmissions.
The HSCRC has a list of the top 15 reasons for a potentially preventable readmission (PPR). The first three constitute a big chunk septicemia, heart failure and chronic obstructive pulmonary disease (COPD). All told, these 15 PPRs represent 42 percent of charges on PPRs for a 30-day readmission time window.
We also have listed the top 15 initial admissions that are followed by one or more PPRs. The top three have changed positions a bit compared with the reason for the readmission is the initial reason for the admission. Again, the top three are heart failure, COPD and septicemia.
We also looked at the top five PPR reasons for an initial admission of heart failure. We delved down into heart failure because it’s a critical one. The top reasons for readmission in 2007 for 15 and 30 days are heart failure, renal failure, septicemia, respiratory system, ventilator support and pulmonary edema. Those are the heart failure reasons why people come back most frequently.
We then looked at length of stay and charges for initial admissions followed by a PPR. We wanted to make sure we were not seeing a shorter length of stay followed by a readmission in other words, the patient got out quicker, was too sick and then was readmitted. We’re seeing that with those readmissions, the length of stay is longer in the initial admission for those who are readmitted, not shorter for both 15 and 30 days.
There were 472,380 admissions or candidates for having a subsequent PPR and 31,873 admissions were followed by one or more PPRs. The formula to calculate the PPR rate is as follows: 6.75=31,873/472,380. The admissions that had a readmission go over the candidates for admission. The important thing to recognize is that there are exclusions to patients that are counted in the mix as being candidates. These exclusions are obstetric patients, newborn patients, patients with multiple traumas who are very sick, patients with multiple malignancies and patients with severe immunosuppression, like AIDS. That’s why not every single patient who is admitted is counted in the denominator; we do remove some people that are excluded.
Overall, $430.4 million in the state in 2007 or almost 200,000 hospital bed days were related to PPRs in our state. For the 30-day numbers, the impact is $656.9 million in charges out of that $800 billion industry in inpatient care and 303,000 hospital bed days. We’re not talking about small money or small impact.